Injection pressure limiter

Avoiding nerve damage during peripheral nerve blocks

Ultrasound-guided localisation of peripheral nerves provide crucial benefits in regional anaesthesia.1) Nonetheless, it is clear that this does not reduce the incidence of permanent nerve damage.2) Even in combination with nerve stimulation, intrafascicular injections cannot be ruled out.1)3)4)5) With the automatic injection pressure limiter NerveGuard, PAJUNK® addresses the preventive position control to avert following damages.

Causes of the development of nerve damage

Intrafascicular injections
If the pressure during intrafascicular injections exceeds the limit value, such injections may demonstrably lead to severe long-term neurological complications.6)7)8) In the case of several hours lasting intrafascicular injections at high pressure, the microvascular blood supply of the nerve is severely restricted, which can lead to degeneration of nerve structures.7)12)

Limiting the injection pressure avoids nerve damage.

Cannula-nerve contact
Direct cannula-nerve contact can also lead to damage of the neural structures with subsequent transient or permanent neurological impairment.10)11) Localisation control using ultrasound and/or nerve stimulation may not in all cases reliably indicate direct cannula-nerve contact.10) Avoiding direct cannula-nerve contact minimises the risk of damage to the nerve wall.11)

A reliable indicator of direct cannula-nerve contact is a high opening pressure.

Cannula-fascia contact
Misinjections into the wrong tissue layers can also be the cause of anaesthesia failure. For example, a high opening pressure can indicate that the tip of the cannula is closed by an in front fascia.9)

One approach to avoid misinjections into wrong nerve tissue structures is to limit the opening pressure.

NerveGuard offers additional support in the localisation of the cannula tip and prevents nerve damage, together with the automatic pressure limitation.